Royal Albert Edward Infirmary

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

Patients were not always sufficiently informed to understand and make judgements about their care, and in some areas this care was not always delivered in a way that was respectful of people’s dignity and privacy. Staff did not always feel safe from violence and aggression in the department and were vulnerable to burnout.

However, we heard examples from patients of positive and patient-centred care from staff, who had the resources and facilities to ensure individual needs were considered. Staff were motivated to respond to patients’ concerns in the moment, and generally had an improved opinion of the working environment compared to the previous year.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

We scored the service as 2. The evidence showed some shortfalls. The service did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity.

Patients reported mixed experiences regarding their experience of the service.

Because of the conditions and capacity of the main waiting room, some patients were unhappy to be told to remain in the space for the time the department required. We spoke with patients and families who felt the arrangement was “cramped”, “very uncomfortable” and many patients said it was too cold. Likely in association with this concern, in CQC’s urgent and emergency care survey 2024, the service performed worse compared to other trusts when patients scored how threatened they felt by other patients or visitors.

Of a sample of 10 patients in the main waiting room on the first day of our assessment, 4 told us that they did not feel as though they had been treated with compassion or dignity. For example, we spoke with a patient’s family who were displeased that she had attended the department by ambulance in a dressing gown and had been told to remain in the waiting room, amongst strangers.

We saw some instances of staff delivering information to patients in settings that were not sufficiently private. While staff advised that patients seen in the Clinical Decisions Ward (CDW) assessment and treatment areas would be moved to more private areas or rooms when appropriate, we saw staff on multiple occasions speaking to patients about their care plans, while they remained in cubicles with other patients seated in close proximity. Desktop computers and computers-on-wheels (COWs) were used effectively to protect patient’s data, and we observed staff locking screens when not in use.

Some patients across the ED and Same Day Emergency Care (SDEC) and most patients in the Paediatric Emergency Care Centre (PECC) reported that staff interactions were positive, advising us that they were “always kind and caring”. A family member of a patient with complex needs highlighted the sensitive and compassionate care they had received in the Initial Senior Assessment Triage (ISAT) area.

The trust took part in Friends and Family Test (FFT) feedback which measured patients’ self-reported experience. Emergency care areas at the location demonstrated worse patient experiences compared to the national average in December 2025, with 69% feedback being positive against a national average of 78% positive. In line with national trends, the emergency department reported a rate of 18% negative experiences in the last 30 days, compared to 7% negative experiences across the organisation. The data had remained mostly consistent throughout 2025, with an increase in positive experiences in the summer months and an increase in negative experiences in winter pressures months.

We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff used an interpreting and translation service which provided access to in person and telephone interpretation services for patients who needed this. During the assessment we did not see this being used, but staff demonstrated good knowledge of how and when interpretation should be provided for patients.

We did not observe any mealtimes during the assessment, but staff told us that patients were offered a choice of food and drink that met a range of dietary needs, including requirements linked to religious and cultural preferences, as well as food allergies and intolerances. Patients we spoke with told us that they were happy with the food and drink offering.

Multi-faith prayer rooms were available on site, and the chaplaincy and spiritual care team could be accessed by people of all faiths and none. Chaplains were available 24 hours a day and were on call if their input was urgently requested. Staff demonstrated good awareness of this and information for patients was present in the department.

The Paediatric Emergency Care Centre (PECC) was imaginatively decorated with a design that was child friendly and balanced for a variety of ages, in line with Royal College of Paediatric and Child Health (RCPCH) guidelines. The PECC waiting room contained safe and appropriate toys for distraction and a nearby quiet room (‘The Otis Suite’) had been designated for children and young people with specific sensory needs, which had also recently been refurbished to include new equipment such as a projector and a cushioned space.

We scored the service as 2. The evidence showed some shortfalls. The service did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Patients were not always sufficiently informed about their care and so were unsure of their rights and choices. We spoke to patients in the main waiting room of the Emergency Department (ED) who had not been told of their plan and so could not say why or for how long they would be waiting. Patients were not always told about how their care would be managed in the department, and so were confused to have returned to the main waiting room amongst patients in various other stages of their care journey.

Particularly at times of high operational pressure, we observed that patients in the main waiting room could not always be seated close to their family or friends, as seats were prioritised for people with the highest needs. We spoke with family members who had been concerned that patients they were accompanying had been moved or that care plans had been decided upon while they were away. For example, we spoke with a patient’s family member who returned to the department after paying for more parking time and had found that his wife had gone and that staff didn’t know that she had been awaiting a CT scan, which caused him significant upset.

Further, patients in escalation spaces (seen in beds or trolleys on the corridor, typically awaiting admission to specialty wards) understood that they were there because of capacity limitations across the ED, but had not received a briefing or been provided any information on how their care would be delivered in this setting. For example, some patients we spoke with on the corridor were unsure if they would be provided meals or receive a medical review while in this space. This was not in line with NHS England guidance on the principles for providing patient care in corridors.

However, we observed staff within the PECC who supported children, young people and their families, and explained things in a child-friendly way. They allowed time for questions and reassured all present by making sure people understood the next steps in their care and treatment journey.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

We saw staff provide emotional support to patients, families, and carers during times of distress and saw that they gave them help and advice when needed. Staff demonstrated they understood patients' personal, cultural, and religious needs. All contact between staff and patients was conducted professionally, sensitively and in a way which respected the emotional wellbeing of both patients and those accompanying them.

We spoke with some patients in the main waiting room who had raised with staff that they were in pain and had not received this in a timely way. However, other patients in the main waiting room and most patients across other areas, including the Urgent Treatment Centre (UTC) and Same Day Emergency Care (SDEC) area told us they had received pain relief quickly when they had asked for it.

Patients in the Majors area beds and in escalation spaces felt that staff were responsive to their immediate needs. A personal care trolley was present in the Majors area so that patients who needed timely care such as bedding or clothing changes could have this provided responsively by staff, and comfort packs were provided to patients on escalation spaces to improve their experience. Some patients in the main waiting room told us that when they had raised with staff that they were cold, they had been offered blankets in response, although this was variable across the duration of our assessment.

However, we observed that it was not always possible for staff in the Frailty SDEC to meet all patients’ needs. Patients attending the ED during the night and who were streamed to the Frailty SDEC would typically remain in the main waiting room until the unit opened at 8.00am. The Frailty SDEC was a seated area only, with the clear intention that this was to encourage regular mobility and limit deconditioning while frail patients awaited discharge. However, because there were no reclining chairs on the unit, this had the consequence that patients were unable to recline or sleep easily despite having been awake and disturbed throughout the night. When we observed the unit in the afternoon, most patients were visibly tired or sleeping under blankets, while seated upright. We later discussed this with the leader of the Frailty SDEC, who advised that the unit was in a ‘test of change’ period and this issue had already been identified, with reclining chairs on order.

We scored the service as 2. The evidence showed some shortfalls. The service did not always ensure or promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Staff feedback during the assessment from most areas indicated a broad feeling of improvement, although there were continued frustrations. Most staff we spoke with felt that their experience at work and the pressures on the service were in a better position that they were in the previous years. We spoke with 2 staff who had intended to leave their role last year due to poor working conditions, who now felt improvements were significant enough to warrant staying. Leaders also described that staff retention in recent years had been a significant challenge. However, in the 2025/26 period, more substantive staff had been recruited across the service (with a whole-time equivalent, WTE, of 49) than had left (with a WTE of 24).

Many staff we spoke with raised violence and aggression from patients as a growing concern. While a staff member was allocated oversight of patients in the main waiting room so that they would be present to manage concerns or queries while patients waited, when capacity was exceeded and delays occurred, staff told us that the waiting room could be an intimidating space. During our visit, inspectors were approached by patients who were frustrated and disruptive due to waiting times and unmet requests.

Staff across the service were also concerned about their wellbeing when patients presented with behavioural disturbances or mental health needs. This was particularly the case in the PECC, where some staff we spoke with described occasions they had experienced physical and psychological harm or had felt vulnerable when older and stronger paediatric patients had attended the department.

Security staff were located in a room directly adjacent to the waiting room and PECC and systems to raise alarms were effective. Staff were trained in conflict de-escalation, and the service had already planned to introduce body-worn cameras to frontline areas in response to concerns. In the 2025/26 period, the ED had reported 73 incidents of violence and aggression from patients.

Staff absences recorded for any reason across the services generally varied between 5 and 10% each month, with a noted peak in January 2026 where 97 absence occurrences were recorded, which represented 16% of all absences in the 2025/26 period and represented higher than average absence rates for NHS services nationally. Staff told us that discussion with their managers took place on their return to work, and that they had the opportunity to discuss their wellbeing during annual appraisals (or performance development reviews, PDRs).

Staff surveys were conducted annually, with most recent results available for review from the 2025 survey. Data showed that the response rate and most metrics had improved from the 2024 survey, with improvements noted in the accessibility and feedback from managers and the provision of reasonable adjustments. However, results from the ‘Accident and Emergency’ staff cohort were on average notably worse than the comparable organisational averages, with questions about burnout and the safety climate having demonstrated modest deteriorations in staff perceptions, from a poor initial position.